Physical examination maneuver
Physical Exam
Chest and Respiratory Inspection
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With the patient breathing quietly, begin inspection with clothing in place. Observe the rate, depth, rhythm, and effort of breathing and any obvious asymmetry of chest-wall movement, accessory muscle use, cyanosis, or pursed-lip breathing. Lift or move the shirt as needed to inspect the chest shape and symmetry and to look for intercostal or supraclavicular retractions or paradoxical movement.
How to Interpret
Showing 13 of 23 findings
Acidosis
Nasal flaring
Rule in
Somewhat helpful
Rule out
—
Evidence:ModerateResearch in progress
Chronic Obstructive Pulmonary Disease
Barrel chest (visual impression of increased anteroposterior diameter)
Rule in
Somewhat helpful
Rule out
—
Evidence:Moderate
Hoover sign
Rule in
Somewhat helpfulDerived CI
Rule out
Somewhat helpfulDerived CI
Evidence:Moderate
Thoracic index (measured anteroposterior-to-lateral chest diameter ratio) ≥0.9
Rule in
Somewhat helpfulWide CI
Rule out
—
Evidence:Moderate
Diaphragmatic Paralysis
Paradoxic abdominal movements, detecting bilateral diaphragmatic weakness
Rule in
InconclusiveWide CI
Rule out
InconclusiveWide CI
Evidence:Moderate
Mainstem Bronchus Intubation
Asymmetric chest expansion
Rule in
Somewhat helpfulDerived CI
Rule out
Minimally helpfulDerived CI
Evidence:Moderate
Mitral Valve Prolapse
Pectus excavatum
Rule in
Very helpfulDerived CI
Rule out
Not helpfulDerived CI
Evidence:Moderate
Pleural Effusion
Asymmetric chest expansion
Rule in
Helpful
Rule out
Somewhat helpful
Evidence:Moderate
Pneumonia
Asymmetric chest expansion
Rule in
—
Rule out
Not helpfulNo CI
Evidence:ModerateResearch in progress
Pulmonary Embolism
Accessory muscle use
Rule in
InconclusiveWide CI
Rule out
Not helpfulDerived CI
Evidence:Moderate
Reduced Left Ventricular Ejection Fraction
Cheyne-Stokes respirations in a patient aged 80 or younger
Rule in
Helpful
Rule out
—
Evidence:Moderate
Cheyne-Stokes respirations
Rule in
Helpful
Rule out
Not helpfulNo CI
Evidence:Moderate
Respiratory Neuromuscular Weakness
Accessory muscle use in patients with ALS
Rule in
InconclusiveWide CI
Rule out
HelpfulDerived CI
Evidence:Moderate
Related Bedside Tests
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Lung Auscultation
Rule in:VHChronic Obstructive Pulmonary Disease, VHPneumothorax, HMainstem Bronchus Intubation +29 more
Rule out:VHChronic Obstructive Pulmonary Disease, HPleural Effusion, SHInterstitial Lung Disease +28 more
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Oxygen Saturation
aka Pulse oximetry
Rule in:HMortality, SHPneumonia, MHCardiac Tamponade +8 more
Rule out:ICCardiac Tamponade, NHHepatopulmonary Syndrome, NHMortality +8 more
🎬Video coming soon
Chest Percussion
Rule in:HChronic Obstructive Pulmonary Disease, HPleural Effusion, SHCardiomegaly +10 more
Rule out:VHCardiomegaly, NHChronic Obstructive Pulmonary Disease, ICLeft Ventricular Dilation +10 more
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Respiratory Rate
Rule in:HReduced Left Ventricular Ejection Fraction, SHCardiopulmonary Arrest, SHPneumonia +10 more
Rule out:MHCardiopulmonary Arrest, MHPulmonary Embolism, NHPneumonia +10 more
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Tactile Fremitus
aka Vocal fremitus
Rule in:HPleural Effusion, IEAtelectasis, IEChronic Obstructive Pulmonary Disease +3 more
Rule out:SHPleural Effusion, IEAtelectasis, IEChronic Obstructive Pulmonary Disease +3 more
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Cardiac Auscultation
Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy +37 more
Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy, VHRight-sided Valvular Lesion +37 more